1891879912 NPI number — ISLAND HAND & UPPER BODY REHABILITATION

Table of content: (NPI 1891879912)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1891879912 NPI number — ISLAND HAND & UPPER BODY REHABILITATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ISLAND HAND & UPPER BODY REHABILITATION
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1891879912
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/13/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 7393
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KILL DEVIL HILLS
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27948-7393
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
252-255-5252
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3210 N. CROATAN HWY
Provider Second Line Business Practice Location Address:
STE 3, 2ND FLOOR
Provider Business Practice Location Address City Name:
KILL DEVIL HILLS
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27948-8516
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
252-255-5252
Provider Business Practice Location Address Fax Number:
252-480-0943
Provider Enumeration Date:
10/25/2006

Additional Information

Authorized Official

Authorized Official Last Name:
CALHOUN
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
D
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
252-255-5252

Provider Taxonomy Codes

  • Taxonomy code: 225X00000X , with the licence number:  2161 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 182600 . This is a "MEDCOST ID" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 044180 . This is a "AETNA ID" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 7301179 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: P00316027 . This is a "RAILROAD MCR ID" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 11387 . This is a "BCBS ID" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".




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